Symptoms usually start gradually, with frequent numbness or tingling in the fingers, especially the thumb and the index and middle fingers. Some people with CTS say their fingers feel useless and swollen, even though little or no swelling is apparent. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people with very severe CTS cannot determine between hot and cold by touch, and may burn their fingertips without knowing it.
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; an overactive pituitary gland; an underactive thyroid gland; and rheumatoid arthritis. Other factors that may contribute to the compression include mechanical problems in the wrist joint, repeated use of vibrating hand tools, fluid retention during pregnancy or menopause, or the development of a cyst or tumor in the canal. Often, no single cause can be identified.
How is carpal tunnel syndrome treated?
Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first.
Splinting. Initial treatment is usually a splint worn at night.
Avoiding daytime activities that may provoke symptoms. Some people with slight discomfort may wish to take frequent breaks from tasks, to rest the hand. If the wrist is red, warm and swollen, applying cool packs can help.
Over-the-counter drugs. In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide some short-term relief from discomfort but haven’t been shown to treat CTS.
Prescription medicines. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve in people with mild or intermittent symptoms. (Caution: individuals with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels.)
Alternative therapies. Acupuncture and chiropractic care have benefited some individuals but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among those with CTS.
Carpal tunnel release is one of the most common surgical procedures in the United States. Generally, surgery involves severing a ligament around the wrist to reduce pressure on the median nerve. Surgery is usually done under local or regional anesthesia (involving some sedation) and does not require an overnight hospital stay. Many people require surgery on both hands. While all carpal tunnel surgery involves cutting the ligament to relieve the pressure on the nerve, there are two different methods used by surgeons to accomplish this.
Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical conditions.
Endoscopic surgery may allow somewhat faster functional recovery and less postoperative discomfort than traditional open release surgery but it may also have a higher risk of complications and the need for additional surgery. The surgeon makes one or two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a tube, observes the nerve, ligament, and tendons on a monitor, and cuts the carpal ligament (the tissue that holds joints together) with a small knife that is inserted through the tube. Following the surgery, the ligaments usually grow back together and allow more space than before. Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some individuals may have infections, nerve damage, stiffness, and pain at the scar. Almost always there is a decrease in grip strength, which improves over time. Most people need to modify work activity for several weeks following surgery, and some people may need to adjust job duties or even change jobs after recovery from surgery..